When Hysteroscopy is the only way out; a case series of endometrial osseous metaplasia

Background: Endometrial osseous metaplasia (EOM) poses diagnostic and treatment dilemmas. Hysteroscopy is the gold standard in the diagnosis of endometrial pathologies and offers optimal treatment for osseous metaplasia. Case presentation: Five new cases of EOM were diagnosed within four years, giving an annual incidence of 5/101 (1.24%) of hysteroscopies and 5/583 (0.21%) of gynaecological surgeries. The patients’ mean age was 35.2 ± 10.0 years The diagnosis was made in all cases during evaluation for infertility with the duration of infertility ranging from 1-14 years. They all had a preceding pregnancy termination. All of the five patients had recurrent vaginal discharge, with durations ranging from 1-23 years. Bone tissue was retrieved from the endometrium in all cases, a long bone was impacted in a cephalo-caudal direction in one of the patients, requiring initial cephalad dislodgement before retrieval. After resection, the vaginal discharge stopped immediately and one of the patients conceived spontaneously and had a term delivery. Conclusion: EOM can best be diagnosed and treated by hysteroscopy. It is mostly preceded by pregnancy termination; with a mid-trimester dilatation and evacuation as the commonest risk factor. The indolent nature of the associated vaginal discharge makes EOM predominantly diagnosed during evaluation for infertility.